Basic Surgery (100q).1

Lean body mass increases.

Total body water increases.

Adipose tissue decreases.

Body weight decreases.

Hypermetabolism.

Fever

Tachypnea

Hyperphagia

Negative nitrogen balance.

Hypotension

Hypoperfusion of tissues.

Hypoxemia

All of the above.

Cytokines act directly on target cells and may potentiate the actions of one another.

Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.

Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.

Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates

There is a decrease in systemic vascular resistance and an increase in venous capacitance.

Tachycardia or bradycardia may be observed, along with hypotension.

The use of an alpha agonist such as phenylephrine is the mainstay of treatment

Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

Dobutamine

Sodium nitroprusside.

Pneumatic antishock garment.

Intra-aortic balloon pump

There are no primary alterations in cardiovascular signs

Signs of increased intracranial pressure may be masked by the hyponatremia.

Oliguric renal failure is an unlikely complication

Rapid correction of the hyponatremia may prevent central pontine injury

This patient is best treated by restriction of water intake.

The total extracellular fluid volume represents 40% of the body weight.

The plasma volume constitutes one fourth of the total extracellular fluid volume

Potassium is the principal cation in extracellular fluid.

The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid

The interstitial fluid equilibrates slowly with the other body compartments.

The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.

With normal renal function, this patient is likely to be volume overloaded.

Proper fluid therapy would be unlikely to include potassium administration

Insulin administration will increase the potassium content of cells.

Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

Age over 70 years.

Chronic malnutrition.

Controlled diabetes mellitus.

Long-term steroid use.

Infection at a remote body site.

Myocardial infarct 4 months previously.

Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl. hemoglobin.

Premature atrial or ventricular contractions on electrocardiogram

A harsh aortic systolic murmur.

Age over 70 years.

Whole blood is the most commonly used red cell preparation for transfusion in the United States.

Whole blood is effective in the replacement of acute blood loss.

Most blood banks in the United States have large supplies of whole blood available.

The use of whole blood produces higher rates of disease transmission than the use of individual component therapies

Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.

Two units of FFP should be given with every 5 units of packed red blood cells in most cases

A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases.

One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis.

One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

History and physical examination.

Complete blood count (CBC), including platelet count

Prothrombin time (PT) and activated partial thromboplastin time (APTT).

Studies of platelet aggregation with adenosine diphosphate (ADP) and epinephrine

An allergic reaction.

An anaphylactoid reaction.

A clerical error.

An acute bacterial infection transmitted in blood.

This formulation is proposed for the use of patients with fulminant hepatitis

Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours.

The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy

In some studies of surgical patients, improvements in mortality have been reported.

Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow

In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied.

Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition

Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated

In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose.

In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding.

CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support

Gallstones occur with the same frequency in diabetes patients as in the healthy population.

The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient.

Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk.

The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.

Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

Prevents the aggressive development of atherosclerosis in diabetic patients

Is not associated with unawareness of hypoglycemia.

Improves peripheral neuropathy

Improves established retinopathy and nephropathy

Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).

The surgical procedure.

The length of the surgical procedure.

The anesthetic technique (e.g., general, regional).

The length of anesthesia.

All of the above.

Earlier mobilization after surgery.

Earlier return of bowel function.

Shorter hospitalizations.

Decreased stress response to surgery.

All of the above

Protein depletion.

Infection

Anemia

Advanced age.

Hypoxia

Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes

Lymphocytes are the primary blood cell involved with this process

The process involves a coating of the cytoplasmic surface known as clathrin

Phagocytosis is performed only by white blood cells and tissue macrophages

The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration

The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium

The selectivity of biologic membranes is highly consistent and seldom changes

The selectivity of cell membranes relates only to ions and not organic compounds